Original article
Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis

Part of this study will be presented as an oral presentation to the International Conference on Pharmacoepidemiology and Therapeutic Risk Management in Barcelona, Spain on August 23-26, 2012.
https://doi.org/10.1016/j.jaad.2012.06.035Get rights and content

Background

Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood.

Objectives

We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice.

Methods

A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments.

Results

A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95% confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72).

Limitations

The study is limited by its reliance on patient recall.

Conclusions

Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.

Section snippets

Study design

As part of a multicenter comparative effectiveness study,26 we conducted a cross-sectional study to determine the reasons for the discontinuation of systemic treatments, biologics, and phototherapy for moderate to severe psoriasis. The study was approved by the University of Pennsylvania and University of Utah Institutional Review Boards and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients.

Setting

Data were collected by 10 dermatologists and 2

Sample characteristics

Data were collected on 1755 eligible patients (5% of patients declined to participate). Among the 1158 patients who reported any previous treatment for chronic plaque psoriasis, 1095 patients reporting at least 1 previous biologic, systemic, or phototherapy were included in the analysis. Patient demographics and clinical characteristics are shown in Table I. Based on self-reported categories on the extent of psoriasis involvement at its worst, 29.5% of patients reported 3% to 10% body surface

Discussion

This study comprehensively characterized patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in clinical practice. We demonstrated different patterns of reasons among systemic, biologic, and phototherapy treatments. Perceived treatment inefficacy and side effects were the predominant issues leading to treatment withdrawal; however, treatment inconvenience and economic barriers were also commonly cited, emphasizing the value of patient-oriented

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    Supported by the T32-AR07465 (Mr Yeung, Ms Wan, Mr Shin) and 1KM1CA156723 (Dr Callis Duffin) training grants from the National Institutes of Health, and the RC1-AR058204 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Dr Gelfand). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

    Disclosure: Dr Van Voorhees has served on advisory boards for Amgen, Abbott, Genentech, Warner Chilcott, and Centocor; as an investigator for Amgen and Genentech; as a consultant for Amgen and Leo Pharma; as a speaker for Amgen, Abbott, and Centocor; and received honoraria from Synta. Dr Callis Duffin has served on advisory boards for Amgen; as a consultant for Amgen and Centocor; as an investigator for Abbott, Amgen, Centocor, and Pfizer; and received payments for lectures from Abbott, Amgen, and Centocor. Dr Krueger has served as a consultant for Abbott, Amgen, and Centocor; had grants from Abbott and Amgen; and received payment for lectures and travel-related expenses from Abbott, Amgen, and Centocor. Dr Kalb has served as a consultant for Abbott, Amgen, Centocor, LEO Pharma, and Stiefel; an investigator for Abbott, Amgen, Astellas, and Centocor; and a speaker for Abbott, Amgen, Centocor, Galderma, LEO Pharma, and Stiefel. Dr Weisman has served as an investigator for Abbott, Braintree Laboratories, Celgene, Cipher Pharmaceuticals, LEO Pharma, Pfizer, Norvartis, and Eli Lily; and received payments for lectures from Abbott and Amgen. Dr Sperber is the medical director of Stephens & Associates, has served as a consultant for Amgen, and had grants or has pending grants from Abbott and Centocor. Dr Bebo is employed by the National Psoriasis Foundation, which receives unrestricted financial support from Amgen, Abbott, Janssen, Stiefel Laboratories, Wyeth, Pfizer, Eli Lilly, Galderma, and PhotoMedex. Dr Gelfand has served as a consultant for Abbott, Amgen, Celgene, Centocor, Novartis, and Pfizer; had grants from Abbott, Amgen, Genentech, Novartis, and Pfizer; and received payment for continuing medical education work related to psoriasis. He received a donation from Amgen to the University of Pennsylvania to further develop Dermatology Clinical Effectiveness Research Network, which was not used for the current study. Mr Yeung, Ms Wan, Dr Brod, Dr Schleicher, Mr Shin, and Dr Troxel have no conflicts of interest to declare.

    Reprints not available from the authors.

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